Health mandate will not affect most

The fight over the individual mandate has been so loud that people may think it will hit nearly everyone, whether they can afford health insurance or not.

But what’s usually overlooked is that the health reform law has so many exemptions that millions of Americans are likely to be off the hook, including a wide range of middle-class Americans. Most Americans already have coverage that satisfies the mandate. And for the rest, the law would create rich subsidies that would help pay for coverage, even for families earning more than $90,000 a year.

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In fact, the mandate would be most likely to hit about 25 million people when it takes effect in 2014 — many of whom are younger, healthier people who were taking the chance of going without health insurance even though they might have been able to afford it — according to MIT economist Jonathan Gruber. That’s out of 272 million nonelderly people.

The mandate has become a powerful political symbol of the Affordable Care Act — Exhibit A of what the law’s critics call government overreach. And the Supreme Court will decide whether Congress overstepped its constitutional powers. But the volume of the debate is out of proportion to the number of people who would actually be affected.

“I think this is a point that the law’s supporters haven’t emphasized enough: The mandate really applies to a select set of people,” said Gruber, who consulted on both the national law and Mitt Romney’s health care overhaul in Massachusetts, which has its own mandate.

Even Joe Antos of the American Enterprise Institute, a critic of the law, plays down the actual impact of the mandate.

“I would say it would affect nobody,” Antos said. He said Republicans’ dislike of the requirement has much more to do with their opposition to “the federal government telling you to do something that is your personal business” than the fear that the mandate will force millions of people to buy something they don’t want.

The poorest Americans are technically exempt from the mandate. But under the law’s Medicaid expansion, which also begins in 2014, they would get essentially free coverage anyway — because the program would cover people with incomes up to 133 percent of the federal poverty level. That would be about $30,000 for a family of four if the law were in effect this year.

Those with incomes between 133 percent and 400 percent of poverty — between around $30,000 and $92,000 for a family of four this year — will have to get insurance, but the law provides substantial subsidies to help make it more affordable.

Families at the bottom of this range would have to pay only 3 percent to 4 percent of their income in premiums, while those at the top would have to pay 9.5 percent. The federal government picks up the rest of the tab.